One of the promised benefits of the Affordable Care Act was to reduce the pressure on emergency rooms by expanding Medicaid and giving the poor better access to primary care.

But instead, a survey by the American College of Emergency Physicians suggests something else.

The organization says President Obama’s health care reform actually has had a destructive effect on the nation’s emergency rooms.

American College of Emergency Physicians, Dr. Jay Kaplin says, “Almost half of emergency physicians polled had already seen a rise in their emergency department visits since January one when expanded coverage of the affordable care act took place.”

Greater Cincinnati has a shortage of 595 primary-care physicians, according to December data from the Cincinnati MD Resource Center, a free physician recruiting service formed by the nonprofit Health Improvement Collaborative of Greater Cincinnati. The area’s 234 primary-care doctors per 100,000 residents compares to an “optimal” number of 261 per 100,000 that U.S. Department of Health and Human Services data would suggest.

The American Academy of Family Physicians has warned of an impending national shortage of 40,000 such physicians by 2020. About 140,000 will be needed in all to meet the needs of the aging population, the group has said, but current trends suggest there will be only about 100,000.The U.S. Census Bureau puts the current number of uninsured at 45 million.

“People can have all the insurance they want, but if they can’t get in to see anyone, it’s not going to do anyone much good,” Kambelos said.

The New York Times also reported on long wait times across the board. The issue is the provider networks, Elisabeth Rosenthal notes, in both public and private coverage. However, she leaves out one key point:

The study found that 26 percent of 2,002 American adults surveyed said they waited six days or more for appointments, better only than Canada (33 percent) and Norway (28 percent), and much worse than in other countries with national health systems like the Netherlands (14 percent) or Britain (16 percent). When it came to appointments with specialists, patients in Britain and Switzerland reported shorter waits than those in the United States, but the United States did rank better than the other eight countries.

So it turns out that America has its own waiting problem. But we tend to wait for different types of medical interventions. And that is mainly a result of payment incentives, experts say.

Americans are more likely to wait for office-based medical appointments that are not good sources of revenue for hospitals and doctors. In other countries, people tend to wait longest for expensive elective care — four to six months for a knee replacement and over a month for follow-up radiation therapy after cancer surgery in Canada, for example.

In our market-based system, patients can get lucrative procedures rapidly, even when there is no urgent medical need: Need a new knee, or an M.R.I., or a Botox injection? You’ll probably be on the schedule within days. But what if you’re an asthmatic whose breathing is deteriorating, or a diabetic whose medicines need adjustment, or an elderly patient who has unusual chest pain and needs a cardiology consultation? In much of the country, you can wait a week or weeks for such office appointments — or longer if you need to find a doctor who accepts your insurance plan or Medicare.

And those waits are likely to get longer as the Affordable Care Act brings tens of millions of newly insured patients into a system that is often already poorly equipped to provide basic care. “I fully expect wait times to be going up this year for Medicaid and Medicare and private insurance because we are expanding access to care, but we’re not really expanding the system of providers,” said Steven D. Pizer, a health care economist at Northeastern University in Boston.

The point missing from this is the incentives provided by ObamaCare to limit provider networks as a means of cost control. Two months ago, the Associated Press belatedly reported on these cost incentives on insurers and the easily predictable results that follow:

Before the law took effect, experts warned that narrow networks could impact patients’ access to care, especially in cheaper plans. But with insurance cards now in hand, consumers are finding their access limited across all price ranges — sometimes even after they were told their plan would include their current doctor.

Michelle Pool is one of those customers. Before enrolling in a new health plan on California’s exchange, she checked whether her longtime primary care doctor was covered. Pool, a 60-year-old diabetic who has had back surgery and a hip replacement, purchased the plan only to find that the insurer was mistaken.

Her $352 a month gold plan was cheaper than what she’d paid under her husband’s insurance and seemed like a good deal because of her numerous pre-existing conditions. But after her insurance card came in the mail, the Vista, California resident learned her doctor wasn’t taking her new insurance. …

Narrow networks are part of the economic trade-off for keeping premiums under control and preventing insurers from turning away those with pre-existing conditions. Even before the Affordable Care Act, doctors and hospitals would choose to leave a network — or be pushed out — over reimbursement issues as insurers tried to contain costs.

Fewer providers with more customers and lower reimbursements mean longer and longer wait times at best. In some cases, it means no effective access to medical care outside of an ER. This isn’t a bug … it’s a feature, and one that will impact more and more Americans under ObamaCare as time goes on.

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It beats my understanding why hospitals don’t ditch new Medicare/Medicaid patients altogether and thus avoid EMTALA’s requirement to accept every third-world turd into ER? That would also instantly drop the charged amounts for many procedures by an order of magnitude.

One of the promised benefits of the Affordable Care Act was to reduce the pressure on emergency rooms by expanding Medicaid and giving the poor better access to primary care.

Obamacare expanded eligibility to Eleventy Gazillion new people but didn’t provide one extra Doctor. And not many Doctors are taking any new Medicare/Medicaid Patients so they have to go to the emergency room when they stub their toe.

And trust me, these newly insured people have been told over and over again that they have a Constitutional Right to see a Doctor for anything that ails them, and by golly they are going to exercise their Right. So they are overloading the only place that will see them with their shiny new Health Insurance. Did anybody seriously expect anything different to happen? I know Obama didn’t.

NY Times: June 26So Much for Obamacare Not Working
Have you been following the news about Obamacare? The Affordable Care Act has receded from the front page, but information about how it’s going keeps coming in — and almost all the news is good. Indeed, health reform has been on a roll ever since March. -Paul Krugman

People never learn. They never learn that applying a third-world solution to a first-world problem will yield third-world results. Go anywhere with a socialized medical system, whether it be Venezuela or Cuba, Puerto Rico or Indonesia, Great Britain or Canada, the Philippines or Norway, Poland or Nauru. I haven’t been to them all, but I’ve been to enough to know that you get two tiers of service: 1 is for rich people in private hospitals behind bulletproof glass staffed by good, English speaking doctors; 2 Is people standing in line for hours in rain, sun, and heat to get into dirty, ill supplied emergency rooms staffed with the medical residents who have to be there to graduate, and the nurses who couldn’t get into medical school, and no one there gives a **** about any of the patients.

People keep missing the other menace of Obamacare. The networks shrink along with the quality of the doctors in them.

The better doctors will avoid Obamacare patients to the extent possible for economic reasons alone. These doctors will want to either supplement their Obamacare patients with a private practice geared to the affluent first and foremost or avoid Obamacare networks altogether.

Government programs that pay for healthcare generally underpay providers (paying less than the cost of the service), so providers who accept those payments must overcharge other patients to try to cover the shortfall.

Insurance companies don’t want to have to pay more because of this, so they’ve limited provider networks to those doctors and hospitals with lower cost, which are generally going to be those who do not accept Medicare/Medicaid. Without that drag on their bottom-line, they don’t have to increase the price charged to other payers.

As long as there is a free-enterprise element in the health care system, this is going to happen. It’s basic economics. The government element and ‘price control’ is anything but free-enterprise, and the economic reality of price controls when people have a choice, is shortages of those goods and services subject to the price controls.

The ‘solution’, which is the ‘worst kept secret’ goal of the Democrats, is a complete government takeover, and ‘single payer’. Like most government solutions it will make many of the problems more entrenched and the system less responsive to individual needs, but the Democrats seem to think that government will excel in the health-care arena (for this country), unlike all the other arenas (and countries) where it performs so badly. (How about that VA anybody?)

Or maybe they don’t care, as long as government gets bigger and more powerful.

They never learn that applying a third-world solution to a first-world problem will yield third-world results. Go anywhere with a socialized medical system, whether it be Venezuela or Cuba, Puerto Rico or Indonesia, Great Britain or Canada, the Philippines or Norway, Poland or Nauru.

JoseQuinones on July 7, 2014 at 3:50 PM

So true.

I’m fortunate enough to not have to depend on Obamacare for my health insurance. I also know from growing up – and having family in Canada that unless one is going to pay additional to travel to the US for treatment – one’s treatment there is going to be far worse than here in the US.

In fact, I can compare and contrast my treatment (private non-Obamacare insurance) here in the US for cancer compared to that an uncle received entirely under the Canadian government…

In Canada, from initial diagnosis of prostrate cancer to the first visit with the Oncologist – 7 months. 4 additional month wait for the CT scan – and his surgery was nearly 13 months after his diagnosis.

I was diagnosed with colon cancer the 3rd week of March this year. I saw my Oncologist 2 weeks later, and had a CT scan the next day. My surgery to remove the cancerous areas (we learned that it had just started to spread to the lymph nodes) was 3 weeks to the day of my diagnosis.

I shudder to think what my prognosis would be if I had to wait just over a year for the surgery.

If genuinely asking, health insurance providers strike deals with healthcare providers. When Obamacare expanded the scope of benefits that had to be included in a qualifies health plans (including measures that prevented refusal of coverage to people with pre-existing conditions), this drove up prices, which means health insurers had to cut costs in other ways…namely with the deals struck with providers.

The networks became narrower because some of the health care providers couldn’t provide services at the reimbursement rates being offered by the health insurance companies.

So every single thing thing obamacare was meant to accomplish…. It does the EXACT opposite… Yet every Dem politician is ready to die on the hill to defend it… And half of the Republicans secretly love it too. They really truly don’t give a damn about this country and it’s citizens

It beats my understanding why hospitals don’t ditch new Medicare/Medicaid patients altogether and thus avoid EMTALA’s requirement to accept every third-world turd into ER? That would also instantly drop the charged amounts for many procedures by an order of magnitude.

Rix on July 7, 2014 at 3:30 PM

Because many hospitals are designated ” district” community hospitals and public taxes either helped to build them or fund them. They can not refuse Medicaid ,Medicare patients.

If only someone had warned us of this. You know like going to town hall meeting with the bill in hand reading for all to hear the parts that could end up resulting in just type of thing happening. Instead it was just a bunch of old white ladies drinking tea or something.

There is no way in the world to increase the number of patients while simultaneously decreasing the availability of doctors and say that health care cost will be reduced.

Instead of implementing universal cost controls which have never worked, the government would have been more effective if it had paid the cost of medical students in order to increase the number of doctors and thereby increase competition which would lower health care costs.

Alas, it is apparent that there are no liberals who understand the concept of supply and demand. When supply is limited and demand goes up, then prices go up. That’s Obamacare today. When demand is limited and supply goes up, prices go down.

The most effective way to lower medical cost is to increase the number of doctors and hospitals who will naturally adjust their costs to compete in the free market. Those doctors and hospitals that offer lower prices will attract more patients looking to maximize their limited resources for health care.

And Obama when to Harvard? That doesn’t say much for a Harvard education.

I learned about supply and demand running a lemonade stand–a step in understanding economics that Obama and 99% of government bureaucrats apparently skipped.

It beats my understanding why hospitals don’t ditch new Medicare/Medicaid patients altogether and thus avoid EMTALA’s requirement to accept every third-world turd into ER? That would also instantly drop the charged amounts for many procedures by an order of magnitude.

Rix on July 7, 2014 at 3:30 PM

Federal law says hospitals may not turn anyone away. Regardless of ability to pay, citizenship, etc. If a patient is non-english speaking the hospital must provide an interpreter at its cost. This also applies to primary care docs in private practice. Interpreters qualified for medical issues run about $100/hr. Don’t ask how I know. Obviously serving these patients results in a loss that you get to make up in the form of higher fees.

It is fine that my son had to wait four hours to get a broken arm set as the entire ER was full of Spanish speaking people with children that had colds. I guess if it hurts whitey it’s the best thing for the country.

Again, can any of the low IQ democrat trolls (BIRM, BIRM) point out any of the criticism of Obama-Democrat Care that has been proved wrong? Can any of them point out one point where Obama did not lie his a$$ off?

The funny thing is leftists think they are the smart ones but are never correct.

When will VOX come out and explain to all of us rubes that longer wait times in the ER was what Obama actually said and that it is good for all of us to wait longer.

Just wait until all those future democrat voters spread the diseases they came in with and completely overwhelm our ER system. Before the Obama led invasion California had 10-12 ER close down because of those adorable little 6XXL underwear wearing, balding, darlings in the country illegally.

Wait times for seeing doctors have become an issue even outside the VA, which was a totally predictable outcome of ObamaCare. What wasn’t predicted was that the impact on wait times would be seen in emergency rooms, since one of the arguments for ObamaCare was to shift patients out of ERs and into clinics with an expansion of coverage.

Ed Morrissey on July 7, 2014 at 3:21 PM

.
That is undoubtedly how the White House predicted things would roll, but I’m pretty sure all of us here saw this coming, with the up-most clarity.
.
Meanwhile, what’re the “wait times” at those clinics like ?

These newly insured people are used to going to the ER for everything. Anyone who thought handing them an Obamacare card was going to get them to call a doctor’s office and wait a week or two was an idiot.

It beats my understanding why hospitals don’t ditch new Medicare/Medicaid patients altogether and thus avoid EMTALA’s requirement to accept every third-world turd into ER? That would also instantly drop the charged amounts for many procedures by an order of magnitude.

Rix on July 7, 2014 at 3:30 PM

.
Federal law says hospitals may not turn anyone away. Regardless of ability to pay, citizenship, etc. If a patient is non-english speaking the hospital must provide an interpreter at its cost. This also applies to primary care docs in private practice. Interpreters qualified for medical issues run about $100/hr. Don’t ask how I know. Obviously serving these patients results in a loss that you get to make up in the form of higher fees.

JLyons on July 7, 2014 at 4:37 PM

.
What d’ya mean “serving these patients results in a loss that you (the hospitals) get to make up in the form of higher fees”?
.
That sounds suspiciously like private-sector “communism” to me.

There are two anti free trade features of Medicare since it was formed. The first is that there is an incredible amount of paper work required. The second is that if Medicare is used, the doctor may not charge a fair price to be paid by Medicare plus cash and or insurance. I wonder why Medicare does not appeal to potential family practitioners.

Imaging the scene in Idiocracy where the lawyer is standing there going “Um,” while Not Sure is keeping the door from closing and trying to work out the time paradoxes.

If genuinely asking, health insurance providers strike deals with healthcare providers. When Obamacare expanded the scope of benefits that had to be included in [qualifying] health plans (including measures that prevented refusal of coverage to people with pre-existing conditions), this drove up prices

with you

which means health insurers had to cut costs in other ways

still with you

. . . namely with the deals struck with providers.

Um

The networks became narrower because some of the health care providers couldn’t provide services at the reimbursement rates being offered by the health insurance companies.

lineholder on July 7, 2014 at 4:09 PM

Um

. . . :

Narrow networks are part of the economic trade-off for keeping premiums under control and preventing insurers from turning away those with pre-existing conditions.

That sounds like deliberate engineering, for the purpose of keeping premiums down, not an effect, but a cause. How could doing this deliberately keep premiums down?

–If I misunderstood — it wasn’t meant to imply deliberate engineering — how could it keep the premiums down?

Simple fix for the Prez with the Pen. Simply declare that to keep med licenses and/or board certifications, docs must meet a certain quota of Mediscare/Obamascare patients. And, every year, that percentage goes up.

Simple fix for the Prez with the Pen. Simply declare that to keep med licenses and/or board certifications, docs must meet a certain quota of Mediscare/Obamascare patients.

If the fascist-democrat party gets control of the congress you can bet your bottom dollar that there will be a “Doctor Fairness and Affordability” law. As in everything progressive totalitarian the name of the law is the exact opposite.

The nurse at our hospital asked my wife if she was feeling any more pain in the recovery room after shoulder surgery. She said there was a shortage of the iv drip clear liquid stuff running to her forearm. She also said lots of other various unusual things were running short lately. Any one else hear this? Does it relate you think?